Teaching NeuroImage: Paraneoplastic Cerebellar Degeneration and Antibodies to TRIM 9 and 67 Secondary to Melanoma

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Paraneoplastic cerebellar degeneration (PCD) has been described in a few isolated patients with melanoma and different neuronal antibodies (Yo and CARPVIII). 1 A 63-year-old woman developed a subacute severe pancerebellar syndrome.At clinical examination, she exhibited bilateral gaze-evoked nystagmus, down-beat nystagmus, left dysmetria, and gait ataxia.Brain MRI showed severe cerebellar edema (Figure1).Antibodies to tripartite motif proteins (TRIM) 9 and 67 were detected in both serum and cerebrospinal fluid by rat brain immunohistochemistry and immunoblot (Euroimmun, Germany).These antibodies have previously been described in two patients with PCD 2 .Cancer work-up identified a BRAF-mutated metastatic melanoma without brain involvement.Immunohistochemistry of paraffin-embedded melanoma section with a polyclonal rabbit antibody against TRIM9 (RRID AB_2815650; Thermo-Fisher-Scientific, USA) was positive in the tumor cells suggesting TRIM9 expression by the tumor (Figure2).Patient deteriorated despite treatment with corticosteroids, immunoglobulins, and rituximab, remaining unable to walk independently 18 months later.Anti-BRAF treatment yielded partial oncological response.

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